WASHINGTON - Congressional Budget Office Director Douglas W. Elmendorf Wednesday said the number of people without health insurance could grow to 54 million within a decade.

"Without changes in policy, CBO estimates that the average number of non-elderly people who are uninsured will rise from perhaps 48 (million) or 49 million this year to about 54 million a decade from now," Elmendorf said in testimony before the Senate Finance Committee.

Elmendorf said the growth in healthcare spending, driven largely by development of new treatments and technologies, is imposing an untenable burden on both the U.S. government and the private sector. One approach for reducing these costs would be to move away from fee-for-service to incentives for controlling costs and ensuring value.

"Exactly how to create these incentives is, unfortunately, less clear," he said. "A number of alternative approaches could be considered and are discussed in our volumes, including fixed payments per patient, bonus payments based on performance or penalties for substandard care."

In opening the hearing, Sen. Max Baucus, D-Mont., said we no longer have the luxury of waiting on healthcare reform.

"Comprehensive health reform is no longer simply an option. It's an imperative. We cannot afford to delay healthcare reform. Delay will make the problems that we face today even worse," Baucus said, calling on the CBO "to find a pathway to health reform."